Interactive Intensive Gait Training in Walking Limitations (Gait-MAP)

Participants assigned to this arm will receive Intensive Interactive Gait Training (IIGT) using a sensorized treadmill with body-weight support and interactive virtual reality-based exercises providing real-time visual and auditory feedback. The intervention will consist of approximately 15 sessions of 45 minutes each and will be integrated into the standard multidisciplinary rehabilitation program.

Intensive Interactive Gait Training (IIGT) will be delivered using a sensorized treadmill with body-weight support and interactive virtual reality-based exercises providing real-time visual and auditory feedback. The intervention will simulate real-life walking challenges and will be tailored to each participant's functional status, limitations, and rehabilitation goals. Training will be task-specific and of moderate-to-high intensity. Participants will receive approximately 15 sessions of 45 minutes each, integrated into the standard multidisciplinary rehabilitation program.

Participants assigned to this arm will receive conventional gait rehabilitation with the same treatment period, duration, frequency, and intensity as the experimental group, according to national and international guidelines for neurological gait rehabilitation. The intervention will be integrated into the standard multidisciplinary rehabilitation program.

Conventional gait rehabilitation will be delivered over the same treatment period, with comparable duration, frequency, and intensity as the experimental intervention. Treatment will follow national and international recommendations for neurological gait rehabilitation and will be individualized according to each participant's functional status, limitations, and rehabilitation goals. The intervention will be integrated into the standard multidisciplinary rehabilitation program.

Cost of Walking (CW) represents the energy expenditure required to walk at a given speed and provides an index of walking efficiency. It will be assessed through cardiopulmonary exercise testing (CPET), based on oxygen consumption (VO₂), carbon dioxide production (VCO₂), and other metabolic parameters. Lower CW values indicate greater walking efficiency.

The Mini-Mental State Examination (MMSE) is a standardized cognitive screening tool used to assess global cognitive function. It evaluates several cognitive domains, including temporal and spatial orientation, memory, attention and calculation, language, and visuoconstructive abilities. The total score ranges from 0 to 30, with higher scores indicating better cognitive performance. The MMSE is widely used in clinical practice and research to screen for cognitive impairment and monitor changes in cognitive function over time.

The Fatigue Severity Scale (FSS) is a standardized self-reported questionnaire used to assess the severity of fatigue and its impact on daily activities and functional performance. It consists of 9 items, each rated on a 7-point Likert scale (1 = strongly disagree; 7 = strongly agree). The total score ranges from 9 to 63, with higher scores indicating greater fatigue severity and a more significant impact on daily functioning. The FSS is widely used in clinical practice and research to evaluate fatigue and monitor changes over time.

The Medical Research Council (MRC) Scale is a standardized clinical assessment tool used to evaluate muscle strength. It measures voluntary muscle contraction using a 6-point grading system ranging from 0 to 5, where 0 indicates no visible or palpable muscle contraction and 5 represents normal muscle strength. Intermediate scores reflect varying degrees of muscle activation and the ability to perform movements against gravity and resistance. Higher scores indicate greater muscle strength. The MRC scale is widely used in clinical practice and research to assess muscle weakness and monitor changes in motor function over time.

The Modified Ashworth Scale (MAS) is a standardized clinical assessment tool used to evaluate muscle spasticity by measuring resistance to passive movement. It assesses muscle tone using a 6-level grading system (0, 1, 1+, 2, 3, and 4), where 0 indicates no increase in muscle tone and 4 represents rigidity of the affected limb in flexion or extension. Higher scores indicate greater resistance to passive movement. The MAS is widely used in clinical practice and research to assess muscle hypertonia and monitor changes in muscle tone over time, particularly in patients with neurological disorders.

The 6-Minute Walk Test (6MWT) is a standardized functional assessment tool used to evaluate walking endurance and functional exercise capacity. It measures the total distance walked in meters over a period of 6 minutes, during which participants are instructed to walk as far as possible at a self-selected pace along a standardized walkway. The total distance covered represents the primary outcome measure, with greater distances indicating better functional exercise capacity and walking endurance. The 6MWT is widely used in clinical practice and research to assess functional mobility and monitor changes in walking performance over time, particularly in patients with neurological, cardiovascular, and respiratory disorders.

The Timed Up and Go (TUG) is a standardized clinical assessment tool used to evaluate functional mobility, dynamic balance, and fall risk. The test measures the time required, in seconds, for a participant to stand up from a chair, walk a distance of 3 meters at a comfortable and safe pace, turn around, walk back to the chair, and sit down. The total completion time represents the primary outcome measure, with shorter times indicating better functional mobility and balance performance. The TUG is widely used in clinical practice and research to assess mobility limitations and monitor changes in functional performance over time, particularly in patients with neurological and musculoskeletal disorders.

The Timed Up and Go Dual Task (TUG-DT) is a standardized clinical assessment tool used to evaluate functional mobility, dynamic balance, and cognitive-motor interference under dual-task conditions. The test measures the time required, in seconds, for a participant to stand up from a chair, walk a distance of 3 meters, turn around, walk back to the chair, and sit down while simultaneously performing a secondary cognitive task, such as counting backward or verbal fluency. The total completion time represents the primary outcome measure, with shorter times indicating better dual-task mobility performance. The TUG-DT is widely used in clinical practice and research to assess cognitive-motor interactions, identify mobility limitations, and monitor changes in dual-task performance over time.

The 10-Meter Walk Test (10MWT) is a standardized clinical assessment tool used to evaluate walking speed and functional mobility. The test measures the time required, in seconds, for a participant to walk a distance of 10 meters at a comfortable or maximum safe walking speed, according to the assessment protocol. Walking speed is calculated in meters per second (m/s) by dividing the measured distance by the time required to complete it. Higher walking speeds and shorter completion times indicate better walking performance. The 10MWT is widely used in clinical practice and research to assess gait impairments, functional mobility, and changes in walking performance over time, particularly in patients with neurological and musculoskeletal disorders

The Functional Ambulation Classification (FAC) is a standardized clinical assessment tool used to evaluate walking ability and the level of physical assistance required during ambulation. It classifies functional walking independence using a 6-point ordinal scale ranging from 0 to 5, where 0 indicates non-functional ambulation or the need for assistance from two or more people, and 5 represents complete independence in walking on various surfaces, including stairs. Higher scores indicate greater walking independence and reduced need for physical assistance. The FAC is widely used in clinical practice and research to assess functional mobility, monitor gait recovery, and evaluate changes in walking independence over time, particularly in patients with neurological disorders.

The Modified Barthel Index (MBI) is a standardized clinical assessment tool used to evaluate functional independence in activities of daily living (ADLs). It assesses 10 domains, including feeding, bathing, grooming, dressing, bowel and bladder control, toilet use, transfers, mobility, and stair climbing. The total score ranges from 0 to 100, with higher scores indicating greater functional independence and lower levels of disability. The MBI is widely used in clinical practice and research to assess functional limitations, monitor changes in independence over time, and evaluate rehabilitation outcomes, particularly in patients with neurological and musculoskeletal disorders.

The 36-Item Short Form Health Survey (SF-36) is a standardized self-reported questionnaire used to assess health-related quality of life and overall health status. It consists of 36 items covering eight health domains, including physical functioning, role limitations due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health. Each domain is scored on a 0-100 scale, with higher scores indicating better perceived health and quality of life. The SF-36 also provides two summary measures: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). It is widely used in clinical practice and research to evaluate health-related quality of life and monitor changes in physical and mental well-being over time, particularly in patients with chronic conditions and disabilities.

The Activities-specific Balance Confidence Scale (ABC Scale) is a standardized self-reported questionnaire used to assess an individual's confidence in maintaining balance while performing various activities of daily living. It consists of 16 items, each rated on a scale from 0% (no confidence) to 100% (complete confidence). The total score is calculated as the average of the 16 item scores, ranging from 0% to 100%, with higher scores indicating greater balance confidence and lower perceived risk of losing balance. The ABC Scale is widely used in clinical practice and research to assess balance-related self-efficacy, identify limitations in daily activities, and monitor changes in balance confidence over time, particularly in patients with neurological and musculoskeletal disorders.

The Walking Handicap Scale (WHS) is a standardized clinical assessment tool used to evaluate functional walking ability and the level of independence in household and community ambulation. It classifies walking performance using a 6-point ordinal scale ranging from 1 to 6, where 1 indicates walking limited to therapeutic or exercise purposes and 6 represents unrestricted community ambulation. Intermediate scores reflect varying degrees of walking independence and limitations in navigating different environments, including household and community settings. Higher scores indicate greater walking independence and fewer mobility restrictions. The WHS is widely used in clinical practice and research to assess functional walking limitations, community mobility, and changes in ambulation ability over time, particularly in patients with neurological disorders.

The Community Integration Questionnaire (CIQ) is a standardized assessment tool used to evaluate the level of community participation and social integration in individuals with disabilities. The original version consists of 15 items covering three main domains: home integration, social integration, and productive activities, including work, education, and volunteer activities. The total score ranges from 0 to 29, with higher scores indicating greater independence and community integration. The CIQ is widely used in clinical practice and research to assess participation in everyday life, evaluate rehabilitation outcomes, and monitor changes in social and community functioning over time, particularly in patients with neurological disorders.

The Zarit Burden Interview (ZBI) is a standardized self-reported questionnaire used to assess the perceived burden experienced by caregivers of individuals with chronic illnesses or disabilities. The original version consists of 22 items evaluating the physical, emotional, social, and psychological impact of caregiving responsibilities. Each item is rated on a 5-point Likert scale ranging from 0 (never) to 4 (nearly always). The total score ranges from 0 to 88, with higher scores indicating greater caregiver burden. The ZBI is widely used in clinical practice and research to assess caregiver distress, evaluate the impact of caregiving on quality of life, and monitor changes in perceived burden over time.